Open Access Journal of Medical and Clinical Studies

Volume 2 Issue 2
Review Article

Urbanization, Environmental Pollution & Skin Aging

AK Mohiuddin*
Assistant Professor of Pharmacy, World University, Bangladesh

Article Info Abstract

Article History:
Received: 31 July, 2019
Accepted: 26 August, 2019
Published: 30 August, 2019
*Corresponding author: AK
Mohiuddin, World University, And
Plot: 5 - 8, Avenue 6 & Lake Drive
Road, Sector: 17/H, Uttara, Dhaka -
1230, Bangladesh; Tel: +8802-
9110553; E-mail: trymohi@gmail.com
The skin aging process, which is prompted by environmental variables, is named untimely or
extrinsic skin aging process and can be recognized from the sequentially (intrinsic) skin aging
process by trademark skin aging signs. Youngsters are known to be increasingly defenseless
against the antagonistic health impacts of air pollution. Heavy metals, for example, cadmium,
lead and mercury are regular air pollutants that posture health hazards because of
bioaccumulation. Ozone in the stratosphere has protective impacts by sifting solar UVR; be that
as it may, in the troposphere ozone has toxic implications for skin. Because of scarcity of logical
proof, there are no settled rules as of now accessible for protecting the skin against air pollution.
Besides lessening presentation, potential protection techniques should concentrate on fixing the
skin barrier, renewing antioxidant save, and diminishing inflammation brought about via air
pollutants.

Keywords: Skin aging; Particulate matter; Reactive oxygen species; Collagen disruption;
Aryl-hydrocarbon receptor; Photo aging
Copyright: © 2019 AK Mohiuddin. This is an open-access article distributed under the terms of
the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.

exposure to fine particulate matter with a diameter of less than

Introduction
Skin is the body's largest organ, acts as a protective barrier that
helps preserve our internal fluids and organs. Once this barrier is
compromised, lipids and collagen (responsible for delivering
hydration and plumpness to the skin) start to break down and the
complexion suffers. Cue an increase in dry patches, spots and an
overall lack of glow. This happens because highly unstable
molecules, referred to as free radicals, derived from environmental
pollutants. Urban people change their environment through their
consumption of food, energy, water, and land. And in turn, the
polluted urban environment affects the health and quality of life
of the urban population (Source: Hufton C. The facts on how
pollution is impacting your skin. The Telegraph, 22 February
2019).
Schraufnagel et.al, 2019 given estimation that about 500,000 lung
cancer deaths and 1.6 million COPD deaths can be attributed to
air pollution, but air pollution may also account for nearly 20% of
all cardiovascular deaths and 21% of all stroke deaths [1]. Air
pollution is prematurely ageing the faces of city dwellers by
accelerating wrinkles and age spots, according to emerging
scientific research [2]. Wang et.al, 2018 and Liang et.al, 2019
reported that over 50% of the global population lives in urban
areas since 2011- this is 3.9 billion, and by 2030, this number will
rise to about 5 billion (more than 70%) [3,4]. According to special
reports of Health effect Institute, Boston published in 2018,
2.5 μm (PM2.5) accounts for about 4.2 million premature deaths
in 2016 [5]. PM2.5 rather than PM10 may be responsible for PM-
induced toxicity. Pecorelli et.al, 2019 pointed on ozone (O3),
particulate matter (PM), and cigarette smoke, as some of the most
noxious pollutants that city dwellers are exposed very day. Since
the skin is the first line of defense against environmental insults,
it is considered one of the main target organs for the harmful
insults of air pollution [6]. NOx, CO, SO2, ozone, and volatile
organic compounds (VOCs) are the most common gaseous
pollutants. PM0.1 and other PMs are known to exert deleterious
effects by acting as a “Trojan Horse” and carrying additional toxic
compounds on their surface, including bacteria, carcinogens,
acids, POPs, and metals. Sources of airborne mercury particles
include combustion of coal and other fossil fuels. Urban
communities and neighborhoods located near busy roads are
exposed to high levels of TRP. Mancebo et.al, 2015 stated that
ambient air pollutants exert deleterious effects on the skin by
generating free radicals, inducing cutaneous inflammatory
cascades, activating AhR dependent mechanisms, and altering
cutaneous microflora [7]. Furthermore, pollutant substances,
mainly particulate matter (PM10, PM2.5), accelerate skin aging
through specific activation of intracellular receptors called AhRs
(aryl-hydrocarbon receptors), as depicted by Milani et.al, 2019
[8]. Napolitano et.al, 2018 demonstrated that AhRs are involved
in the pathophysiology of skin, including skin hyperpigmentation,

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Citation: AK Mohiuddin (2019). Urbanization, Environmental Pollution & Skin Aging. J Med Clin stud 2(2): 113
photocarcinogenesis and skin inflammation [9]. Polycyclic
aromatic hydrocarbons (PAHs), adsorbed on the surface of
suspended PM, can trigger the arylhydrocarbon receptor (AhR)
signaling pathway. The AhR might not only lead to an increased
production of ROS, but also indirectly mediate transcriptional
Figure 1: Urbanization, Pollution and Skin Aging.
Gutiérrez-Vázquez et.al, 2018 stated that AhR is expressed by a
number of immune cells, and thus, AhR signaling provides a
molecular pathway that integrates the effects of the environment
and metabolism on the immune response [12]. An older study
shows direct link between the chronic exposure to traffic-related
particulate matter and the occurrence of prominent skin aging
signs especially pigment spots, but also wrinkles in Caucasian
women [13]. Schikowski et.al, 2019 further added that UVR is
another important environmental factor which can cause skin
aging and pigment spot formation. In a real exposure situation,
human skin is exposed to both PM and UVR simultaneously [14].
Peng et.al, 2017 added further suggested that the effects of air
pollutants might be amplified in the presence of other air
pollutants in conjunction with UVR [15]. According to
Araviiskaia et.al, 2019 pollutants reach the superficial and deeper
skin layers by transcutaneous and systemic routes [16]. Fuks et.al,
2019 says short-term exposure to ozone (O3) elicits an oxidative
stress response in human, which leads to aberrant transcriptional
expression of genes consistent with increased skin aging [17].
Park et.al, 2018 demonstrated that PM10 contributes to skin
inflammation and skin aging via impaired collagen synthesis [18].
Also, PM negatively affect the human skin and exacerbates
preexisting skin disease [19,20]. PM penetrates skin through hair
follicles or sweat ducts, and across the stratum corneum
(intracellularly or transcellularly) [18]. Also, Mohiuddin, 2019
reviewed that increased levels of 4 - hydroxy -2- nonenal (HNE)
in the skin, in response to pollutants, likely accelerates skin aging
and exacerbates existing skin inflammatory conditions [21].
Pecorelli et.al, 2019 further stated that HNE is the main product of
oxidative stress which derives from the oxidation of ω-6
polyunsaturated fatty acids (PUFAs). HNE is a highly reactive
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expression of genes, which are of known functional relevance for
both wrinkle formation and pigment spot formation [10]. Yu et.al,
2019 further added that indole-3-aldehyde (IAId), a tryptophan
metabolite of the skin microbiota attenuates inflammation in
patients with atopic dermatitis through the AhR [11].
compound that can form adducts with cellular proteins and even
DNA; it is also an efficient cell signaling molecule able to regulate
mitogen-activated protein kinase pathways and the activity of
redox-sensitive transcription factors such as Nrf2, AP1, and NFκB
[6]. Hyun et.al, 2019 stated that atmospheric PM has harmful
effects on humans through increasing the generation of reactive
oxygen species (ROS), which have been reported to promote skin
aging via the induction of matrix metalloproteinases (MMPs),
which in turn can cause the degradation of collagen [22]. An
indirect link between indoor air pollution and skin aging was
established by Li et.al, 2015, showing that the use of fossil fuels
for cooking was associated with skin aging [20]. Bisphenol A
(BPA) is an Endocrine disruptor compound (EDC), capable of
interfering with hormone related pathways and cause adverse
effects. Graziani et.al, 2019 revealed that a total daily uptake via
the skin corresponds to 9.3 μg per day [23]. Although it could
account for as much as 51% of total exposure in occupationally
exposed persons [24]. It may impart infertility, polycystic ovary
syndrome, and endometriosis along with skin irritation and
hypersensitivity. Everyone is exposed to BPA through skin,
inhalation, and digestive system (produced for polycarbonate
plastic, making it one of the highest volumes of chemicals
produced worldwide) [25,26]. Approximately 80% of all
sicknesses and diseases can be attributed to inadequate water
supply and sanitation worldwide [27]. According to New York
Department of Health, chlorine is used to treat drinking water, it's
also a toxic chemical. In large quantities strips the skin of its
natural oils and causes it to dry and crack, which can lead to
wrinkles [28]. Stefanovic et.al, 2019 stated that specified
exposomes of atopic dermatitis are humidity, ultraviolet radiation,
diet, pollution, allergens, water hardness [29]. It is clinically
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Citation: AK Mohiuddin (2019). Urbanization, Environmental Pollution & Skin Aging. J Med Clin stud 2(2): 113
manifested by itching and scratching, dry skin, patchy eczema
especially on flexural locations, exudation, and skin thickening
and discoloration [30]. It is well-documented that clinical
manifestations of aging skin include loss of tone and elasticity,
uneven skin tone, coarsened texture, enlarged pores, irregular
pigmentation, and lines and wrinkles [31]. Acne scarring
accentuates wrinkles later in life. It creates mini "facial crumple
zones" throughout the face, particularly just below the corners of
the mouth [32]. Melibary et.al, 2019 reported that
oxidative/nitrosative stress in the initiation of acne caused by the
ozone, nitrogen dioxide (NO2) and sulfur dioxide as airborne
outdoor pollutants as well as UV-rays, which plays an important
role in the eruption [33]. UV exposure and O3 have also been
found to have an additive effect on antioxidant depletion (vitamin
E) and on lipid peroxidation levels, which could, in turn, lead to
additional additive effects of these stressors. Thus, air pollution to
worsens of acne symptoms [34]. Bocheva et.al, 2019 stated that
air pollutants together with UVA, can act synergistically in
initiation of skin cancers. In addition, PM induce skin aging
through penetration of the epidermal layer of the skin and through
adnexal structures [35]. It is well accepted in the scientific
community that vitamin D compounds protect the skin against the
hazardous effects of many skin aging-inducing agents, including
UVR [36]. According to Mousavi et.al, 2019 air pollutants,
especially ozone and PM can directly affect the cutaneous
production of vitamin D [37]. Our antioxidant defenses such as
vitamins C and E and selenium are obtained from the diet, and
they are important for protection against UV-induced damage,
beneficial for skin health and protection against aging-related
changes. It has also been reported that excessive exposure to
oxidant stress via pollutants or UV irradiation is associated with
depleted vitamin C levels in the epidermal layer [38-41]. Whyand
et.al, 2018 further added that exposure to O3 results in dose
dependent depletion of antioxidants vitamin C and E in the skin
[7], [42]. Studies have shown a clear correlation between these
factors and the appearance of melanosis and wrinkles. In addition
to the UVR that contributes to cellular injury, visible radiation has
an oxidative effect similar to that of infrared radiation via heat
generation [43]. Addor et.al, 2018 demonstrated significant
changes in some of the mechanical properties of the stratum
corneum by UV damage, reduce its cell cohesion and mechanical
integrity; also affects the molecular structure of cell proteins and
lipids [41]. This phenomenon is more marked in acne patients as
the skin lipid film on the surface of the stratum corneum is altered
through an increase in oxidized squalene and a decrease in linoleic
acid [44]. Several experimental studies demonstrated the
detoxifying activities of squalene against a wide range of
chemicals such as arsenic and hexa-chloro-benzene [45]. There is
evidence that metals in PM cause DNA, protein damage as well as
apoptosis of skin cells through the mitochondria-regulated death
pathway [47]. Exposure to metallic mercury higher levels for
shorter periods of time can lead skin rashes [47]. Pb can affect
Langerhans cells (antigen-presenting cells in the skin) in the
production of interleukin 1β and expression of appropriate surface
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antigens (CD54, CD86, HLA-DR). It can also modulate the
immune response of dendritic cells in the skin [48]. Face in
particular is prone to effects of environment such as cold and hot
weather, arid conditions, humidity, dust, pollution, and UVR [49].
Smoking causes premature aging which clinically manifests as
deeper periorbital wrinkling. Premature facial skin aging in
smokers, with a characteristic pattern of wrinkling and orange-
purple skin discoloration, was defined as smoker's face [50].
Smoker's face typically has lines or wrinkles radiating at the right
angles from the upper and lower lips or corners of the eyes, deep
lines on the cheeks, or numerous shallow lines on the cheeks and
lower jaw [40]. An indirect link between indoor air pollution and
skin aging was established by a study showing that the use of fossil
fuels for cooking was associated with skin aging [18], [51,52]. At
the end, some of these environmental exposures are preventable
by protecting the skin against sun exposure or by quitting
smoking, but there are other environmental exposures like air
pollution where up to now no protection is available. Newer
therapeutic interventions should be based on the molecular
mechanism by which air pollutants induce extrinsic skin aging.
Conflicts of Interest
The authors declare no conflict of interest.
Acknowledgement
I’m thankful to Dr. Andrea Vierkötter, IUF–Leibniz Research
Institute for Environmental Medicine; Düsseldorf, Germany for
his valuable time to audit my paper and for his thoughtful
suggestions. I’m also grateful to seminar library of Faculty of
Pharmacy, University of Dhaka and BANSDOC Library,
Bangladesh for providing me books, journal and newsletters.
Abbreviations
Particulate Matter (PM); Aryl-Hydrocarbon Receptors (AhRs); 4
- Hydroxy -2- Nonenal (HNE); ω-6 Polyunsaturated Fatty Acids
(PUFAs); reactive oxygen species (ROS); Matrix
Metalloproteinases (MMPs); Polycyclic Aromatic Hydrocarbons
(PAHs); Volatile Organic Compounds (VOCs); Traffic-Related
Pollution (TRP); Indole-3-Aldehyde (IAId); Reactive Oxygen
Species (ROS); Matrix Metalloproteinases (MMPs); Endocrine
Disruptor Compound (EDC)
References
1. Schraufnagel DE, Balmes JR, Cowl CT, De Matteis S, Jung SH,
Mortimer K, et al. Air Pollution and Noncommunicable Diseases: A
Review by the Forum of International Respiratory Societies'
Environmental Committee, Part 2: Air Pollution and Organ Systems.
Chest. 2019; 155: 417-426.
2. Carrington D. Air pollution causes wrinkles and premature ageing,
new research shows. The Guardian, 2016.
3. Wang Q. Urbanization and Global Health: The Role of Air Pollution.
Iran J Public Health. 2018; 47: 1644-1652.
3 J Med Clin Stud
Citation: AK Mohiuddin (2019). Urbanization, Environmental Pollution & Skin Aging. J Med Clin stud 2(2): 113
4. Liang L, Gong P, Cong N, Li Z, Zhao Y, Chen Y. Assessment of
personal exposure to particulate air pollution: the first result of City
Health Outlook (CHO) project. BMC Public Health. 2019; 19: 711.
5. Health Effects Institute. State of Global Air. Special Report. Boston,
MA: Health Effects Institute; 2018.
6. Pecorelli A, Woodby B, Prieux R, Valacchi G. Involvement of 4-
hydroxy-2-nonenal in pollution-induced skin damage. Biofactors.
2019.
7. Mancebo SE, Wang SQ. Recognizing the impact of ambient air
pollution on skin health. J Eur Acad Dermatol Venereol. 2015; 29:
2326-2332.
8. Milani M, Hashtroody B, Piacentini M, Celleno L. Skin protective
effects of an antipollution, antioxidant serum containing
Deschampsia antartica extract, ferulic acid and vitamin C: a
controlled single-blind, prospective trial in women living in
urbanized, high air pollution area. Clin Cosmet Investig Dermatol.
2019; 12: 393-399.
9. Napolitano M, Patruno C. Aryl hydrocarbon receptor (AhR) a
possible target for the treatment of skin disease. Med Hypotheses.
2018; 116: 96-100.
10. Krutmann J, Liu W, Li L, Pan X, Crawford M, Sore G, et al.
Pollution and skin: from epidemiological and mechanistic studies to
clinical implications. J Dermatol Sci. 2014; 76: 163-168.
11. Yu J, Luo Y, Zhu Z, Zhou Y, Sun L, Gao J, et al. A tryptophan
metabolite of the skin microbiota attenuates inflammation in patients
with atopic dermatitis through the aryl hydrocarbon receptor. J
Allergy Clin Immunol. 2019; 143: 2108-2119.
12. Gutiérrez-Vázquez C, Quintana FJ. Regulation of the Immune
Response by the Aryl Hydrocarbon Receptor. Immunity. 2018; 48:
19-33.
13. Vierkötter A, Schikowski T, Ranft U, Sugiri D, Matsui M, Krämer
U, et al. Airborne particle exposure and extrinsic skin aging. J Invest
Dermatol. 2010; 130: 2719-2726.
14. Schikowski T, Krutmann J. Air pollution (particulate matter and
nitrogen dioxide) and skin aging. Hautarzt. 2019; 70: 158-162.
15. Peng F, Xue CH, Hwang SK, Li WH, Chen Z, Zhang JZ. Exposure
to fine particulate matter associated with senile lentigo in Chinese
women: a cross-sectional study. J Eur Acad Dermatol Venereol.
2017; 31: 355-360.
16. Araviiskaia E, Berardesca E, Bieber T, Gontijo G, Sanchez Viera M,
Marrot L, et al. The impact of airborne pollution on skin. J Eur Acad
Dermatol Venereol. 2019.
17. Fuks KB, Hüls A, Sugiri D, Altug H, Vierkötter A, Abramson MJ,
et al. Tropospheric ozone and skin aging: Results from two German
cohort studies. Environ Int. 2019; 124: 139-144.
18. Park SY, Byun EJ, Lee JD, Kim S, Kim HS. Air Pollution,
Autophagy, and Skin Aging: Impact of Particulate Matter (PM(10))
on Human Dermal Fibroblasts. Int J Mol Sci. 2018; 19.
19. Hüls A, Vierkötter A, Gao W, Krämer U, Yang Y, Ding A, et al.
Traffic-Related Air Pollution Contributes to Development of Facial
Lentigines: Further Epidemiological Evidence from Caucasians and
Asians. J Invest Dermatol. 2016; 136: 1053-1056.
20. Li M, Vierkötter A, Schikowski T, Hüls A, Ding A, Matsui MS, et
al. Epidemiological evidence that indoor air pollution from cooking
with solid fuels accelerates skin aging in Chinese women. J
Dermatol Sci. 2015; 79: 148-154.
21. Mohiuddin AK. Skin Aging and Modern Age Anti-Aging Strategies.
Austin J Women’s Health. 2019; 6: 1034.
Pubtexto Publishers | www.pubtexto.com
22. Hyun YJ, Piao MJ, Kang KA, Zhen AX, Madushan Fernando PDS,
Kang HK, et al. Effect of Fermented Fish Oil on Fine Particulate
Matter-Induced Skin Aging. Mar Drugs. 2019; 17.
23. Graziani NS, Carreras H, Wannaz E. Atmospheric levels of BPA
associated with particulate matter in an urban environment. Heliyon.
2019; 5(4):e01419.
24. Corrales J, Kristofco LA, Steele WB, Yates BS, Breed CS, Williams
ES, et al. Global Assessment of Bisphenol A in the Environment:
Review and Analysis of Its Occurrence and Bioaccumulation. Dose
Response. 2015; 13: 15.
25. Matuszczak E, Komarowska MD, Debek W, Hermanowicz A. The
Impact of Bisphenol A on Fertility, Reproductive System, and
Development: A Review of the Literature. Int J Endocrinol. 2019;
2019: 4068717.
26. New Jersey Department of health. Hazardous Substance Fact Sheet.
27. Mohiuddin AK. Chemical Contaminants and Pollutants in the
Measurable Life of Dhaka City. Euro J Sustainable Develop Res.
2019; 3.
28. Siddons S. How to Protect Skin from Pollution.
29. Stefanovic N, Flohr C, Irvine AD. The Exposome in Atopic
Dermatitis. Allergy. 2019.
30. Ji H, Li XK. Oxidative Stress in Atopic Dermatitis. Oxid Med Cell
Longev. 2016; 2016: 2721469.
31. Jiang LI, Hino PD, Parker L, Stephens TJ, Mccook J, Gotz V.
Efficacy and Tolerability of an Acne Treatment Regimen with
Antiaging Benefits in Adult Women: A Pilot Study. J Clin Aesthet
Dermatol. 2018; 11: 46-51.
32. Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-
Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet
Dermatol. 2017; 10: 12-23.
33. Melibary YT, Alkeraye S, Alnutaifi KA, Melibary NT, Alsuwaidi
MK, Algzlan HI. Occasional acne; an acne variant. Clin Cosmet
Investig Dermatol. 2019; 12: 219-222.
34. Krutmann J, Moyal D, Liu W, Kandahari S, Lee GS, Nopadon N, et
al. Pollution and acne: is there a link? Clin Cosmet Investig
Dermatol. 2017; 10: 199-204.
35. Bocheva G, Slominski RM, Slominski AT. Neuroendocrine Aspects
of Skin Aging. Int J Mol Sci. 2019; 20: E2798.
36. Reichrath J. Unravelling of hidden secrets: The role of vitamin D in
skin aging. Dermatoendocrinol. 2012; 4: 241-244.
37. Mousavi SE, Amini H, Heydarpour P, Amini Chermahini F,
Godderis L. Air pollution, environmental chemicals, and smoking
may trigger vitamin D deficiency: Evidence and potential
mechanisms. Environ Int. 2019; 122: 67-90.
38. Pullar JM, Carr AC, Vissers MCM. The Roles of Vitamin C in Skin
Health. Nutrients. 2017; 9.
39. Serrano G, Almudéver P, Serrano JM, Milara J, Torrens A, Expósito
I, et al. Phosphatidylcholine liposomes as carriers to improve topical
ascorbic acid treatment of skin disorders. Clin Cosmet Investig
Dermatol. 2015; 8: 591-599.
40. Puri P, Nandar SK, Kathuria S, Ramesh V. Effects of air pollution
on the skin: A review. Indian J Dermatol Venereol Leprol. 2017; 83:
415-423.
41. Addor FAS. Beyond photoaging: additional factors involved in the
process of skin aging. Clin Cosmet Investig Dermatol. 2018; 11:
437-443.
42. Whyand T, Hurst JR, Beckles M, Caplin ME. Pollution and
respiratory disease: can diet or supplements help? A review. Respir
Res. 2018; 19: 79.
4 J Med Clin Stud
Citation: AK Mohiuddin (2019). Urbanization, Environmental Pollution & Skin Aging. J Med Clin stud 2(2): 113
43. Rinnerthaler M, Bischof J, Streubel MK, Trost A, Richter K.
Oxidative stress in aging human skin. Biomolecules. 2015; 5: 545-
589.
44. Dréno B, Bettoli V, Araviiskaia E, Sanchez Viera M, Bouloc A. The
influence of exposome on acne. J Eur Acad Dermatol Venereol.
2018; 32: 812-819.
45. Sethi A, Kaur T, Malhotra SK, Gambhir ML. Moisturizers: The
Slippery Road. Indian J Dermatol. 2016; 61: 279-287.
46. Matthaus B, Özcan MM. Fatty acid, tocopherol and squalene
contents of Rosaceae seed oils. Bot Stud. 2014; 55: 48.
47. Choi JH, Kim JS, Kim YC, Kim YS, Chung NH, Cho MH.
Comparative study of PM2.5 - and PM10 - induced oxidative stress
in rat lung epithelial cells. J Vet Sci. 2004; 5: 11-8.
48. Metryka E, Chibowska K, Gutowska I, Falkowska A, Kupnicka P,
Barczak K, Chlubek D, et al. Lead (Pb) Exposure Enhances
Pubtexto Publishers | www.pubtexto.com
Expression of Factors Associated with Inflammation. Int J Mol Sci.
2018; 19.
49. Jaishankar M, Tseten T, Anbalagan N, Mathew BB, Beeregowda
KN. Toxicity, mechanism and health effects of some heavy metals.
Interdiscip Toxicol. 2014; 7: 60-72.
50. Drakaki E, Dessinioti C, Antoniou CV. Air pollution and skin. Front
Environ Sci 2014; 2: 1-6.
51. Ding A, Yang Y, Zhao Z, Hüls A, Vierkötter A, Yuan Z, et al. Indoor
PM(2.5) exposure affects skin aging manifestation in a Chinese
population. Sci Rep. 2017; 7: 15329.
52. Li M, Vierkötter A, Schikowski T, Hüls A, Ding A, Matsui MS, et
al. Epidemiological evidence that indoor air pollution from cooking
with solid fuels accelerates skin aging in Chinese women. J
Dermatol Sci. 2015; 79: 148-154.
5 J Med Clin Stud